Marty paused outside his door. She had read his chart, seen his prognosis. She tried with patients to gain a mental picture before actually meeting them. She knew that first impressions often determine the course of relationships. She also knew in her line of work that could be disastrous. She had gained a reputation in the course of her residency for being able to gain a patient’s trust early. The relationship established in the first few sessions often spelled success or failure in the patient’s mind. Early trust was the key to long-term success in therapy.
She glanced once more at the chart in her hands. Thomas Daniels. Twenty-three years old. MVA: motor vehicle accident. Long-term prognosis: Poor. Complete nursing care recommended. She sighed. She hoped he didn’t believe it. She took deep breath, planted a smile on her face, and knocked.
“Come in.” The deep voice instantly altered the picture in her mind, but still she was not prepared when she opened the door.
The young man semi-reclined in the bed took her breath away. His ice-blue eyes pierced her heart with their intensity. His nose was slim and straight. His full red-gold beard concealed his mouth. His hair obviously needed washing. His body had begun to waste, but she could still see the outline of muscle in the arms that lie limply at his sides. She glanced at the rail, and wished she hadn’t. She had seen hundreds of urine drainage bags, yet somehow this one seemed wrong. She returned to his disturbing eyes. She could see he had already shut her out.
“Thomas Daniels? My name is Marty Kline. May I call you Thomas?” Her firm steady voice belied the tremor in her stomach. A patient had never flustered her.
“What do you want…?” The slow, deep velvet voice was slurred. Head injury as well as spinal, she forced herself to think clinically.
“What do YOU want?” She countered with a smile. She noticed his beard was darker near his mouth, damp.
“NOT another shrink.” He looked away, dismissing her.
“You’re close, I am a therapist. Your physical therapist.”
“Ahhh, you get to teach me to stop drooling. Go away.”
She wanted to scream at him, but again forced her face to remain calm.
“So, I’ve lost before I begin.” She sighed. “Too bad, though. You see, I thought maybe we could make Dr. Johnson eat his words. But, I can see you’re not interested in my plan. I guess I’ll just tell the doctor to call the nursing home and reserve your room.” She held her breath. A full minute passed. She turned toward the door.
“What plan?” He whispered without looking at her. Hope soared into her heart. She tried to keep from laughing out loud.
“My plan to prove this garbage wrong, of course.” She removed a sheet from his chart, and slowly tore it in half.
“Your prognosis. I’m sure you’ve been fully briefed?” She leaned forward, lowered her voice and exaggerated Dr. Johnson’s accent. “You vill nefer moof aken. You must aggsept it…”
She could see the raw pain in his eyes fighting under the small smile hidden under his beard.
“Do you accept it?” She whispered.
“No.” His eyes shimmered, but he held her solid gaze.
“Good. Now we have a place to start. We’ve got a long way to go though; it’s going to be hard work. Are you ready?” She felt weak, rung out inside.
He nodded, not trusting his voice.
She lowered the head of the bed. The first step had been taken, but their crisis was not over. She conducted a brief exam, testing muscle function, movement and tension. She was not encouraged by her findings. He should have had much more movement and flexibility. She chewed her bottom lip while she pulled, pushed and flexed. She tried to keep her mind on each muscle group she worked, and off his amazing eyes.
“It’s not good, is it?”
Marty flinched at his words. He was right. She smiled her brightest smile. “Right now, no. But, maybe in a month… Trust me, okay?” He nodded.
For the next several minutes, she worked on his hands and arms. Of all he would need to regain, his upper body was critical. If he could get his arms back, he could begin to think about independence.
Marty lifted Thomas’ left hand. His fingers were cold. Marty massaged his hand and wrist. She placed her right hand against his palm to straighten his fingers with hers, and then bent his fingers back slightly to feel if any contractures were forming. She worried about the way his ring and pinky finger were curling toward his palm. She then worked each finger independently, gently bending and rotating each joint.
Thomas watched, fascinated, as Marty worked. He could see the concentration in her face, and wondered if she was aware of her small smiles and frowns as she manipulated his hand. He still hadn’t become accustomed to watching his body being pushed and pulled and not feeling it. As Marty bent over him, he could just smell her perfume, slightly musky. He could see the slight outline of her bra under her shirt. He swallowed hard, and tried to concentrate on his arm, as Marty rotated his wrist. When she grasped his bicep to bend and rotate his elbow, he gasped.
“Did I hurt you?” Marty stopped short.
“No, it’s just that all of a sudden, I could… feel your hand.” Thomas burned with embarrassment. He’d been trying to remember what it was like to feel a girl’s hands somewhere else, when she’d grabbed his arm. When she smiled, and nodded, Thomas wondered if she knew what he’d been thinking.
Marty continued his range-of-motion by extending his arm. With one hand supporting his shoulder, and the other supporting his elbow, she lifted his arm up and out, stretching and rotating gently. Thomas could feel the warmth and strength in her hands. He could imagine how he must look to her. As she lifted his arm, he caught the smell of his own unwashed body. He closed his eyes and tried to focus solely on feeling her hands.
“Did you wear a beard?” Marty knew the staff was competent, and efficient, but a patient’s wants were not always considered needs.
“What?” Thomas had nearly drifted to sleep, soothed by the movement. He had been able to feel slightly more when she had moved to his right side, and as she bent and stretched his arm. She had worked silently, for the most part, and he’d been surprised at how quickly she’d put him at ease.
“A beard, Thomas. You know, that fuzzy stuff all over your face? Do you normally wear a beard?”
Anger blazed into his eyes. “It keeps the drool off my chest.”
“I can see that. Answer the question.” She refused to take the bait.
“No, I don’t… didn’t. Who’s going to shave it?”
“I will for now, if you like. You may later… What about the hair? When was the last time you had it washed?”
“God, I must look as bad as I sound. Way to cheer me up.” He smiled crookedly.
Marty looked at her watch. “We have some time. How about a shave and wash? I won’t even charge you the ten bucks.” She leaned close and touched his shoulder. “By the way, I’m not here to cheer you up.” She whispered with a wicked smile.
He almost laughed, almost. She mentally ran through the conversation as she closed the bathroom door behind her. What was she doing? She frowned into the mirror, suddenly self-conscious. She knew she was attractive. Her dark hair with deep auburn highlights, creamy skin, and clear green eyes made a striking picture… usually. She realized how tired she looked.
Thomas was the last patient at the end of a long day, and Marty knew she should just go home. She couldn’t decide why she wanted to stay. She was dedicated, professional… detached. She didn’t stay after hours to chat with patients, let alone perform ADL’s.
Activities of Daily Living… She reminded herself to check his chart. She knew nurses and aides were busy, and “totals” like Thomas were a lot of work. It was easy enough to just write “refused” next to the ADL box if the patient gave them any sign of resistance. She shook her head as the thought of Thomas never being able to care for himself banged up against the “plan”. She’d never reacted so strongly to a patient. Who was she kidding? She’d never reacted so strongly to anyone. She practiced looking simply cheerful as she gathered the supplies.
Thomas could hear the water running. He tried to fight hope with reason. Reality hit him full force as he looked down at himself. He could see his thinning arms, his still hands, already beginning to curl inward. He could see the outline of his legs under the blankets, the rise of the blanket over his knees, the awkward angle of his feet. He could see them. He could not feel anything below his biceps. He tried to look over the edge of the bed. He couldn’t see it, couldn’t feel it, but he knew the bag was there. He felt his face grow hot. He could feel the tears, and closed his eyes.
“Asleep? In three minutes? That must be some kind of record!” Marty knew they were not out of the woods yet. “Here handsome, take a peak. This is the before shot.” She held up a mirror.
He stared in disbelief. He was speechless. He turned away, and closed his eyes.
“Nope, no sleeping allowed.” She lowered her voice a fraction. “I know you do it when the nurses work with you; just block them out and drift. But I need steady conversation. I can understand you just fine.”
His eyes shone, as he opened his mouth to respond, but could not find any words.
“This is not my first day on the job, you know.” She smiled gently. Time to let up. “I will never tell you I know how you feel.” She continued softy. “But I can tell you I know it gets easier. I believe in you, and I believe in me.”
Marty unlocked the brakes on his bed. She pulled the bed out from the wall. Thomas watched her muscles strain as she pulled on the foot of the bed. He felt slightly guilty for imagining what she’d look like without her shirt. He was so flushed; he doubted if she’d notice just a bit more redness. He wished he could just move his foot a little, her hands were so close.
Marty grunted a little, more from the need for a little release than from actual strain. She could see the way his eyes followed her every movement. She was used to being looked at, but she was not used to being affected by it. She could feel her own cheeks flaming and tried to keep her head down. She suddenly realized what she was feeling.
Marty had always thought of herself as a little cold. She’d dated all through school. She was certainly no virgin. She’d been attracted to, and had experimented with different types of men. She had listened to her friends gush about this guy and that one, and had joined in the conversations often enough. But, she’d never really understood what all the fuss was about. It wasn’t that she didn’t like men, and she definitely liked sex, but she’d never really understood whatever it was that drove her friends to distraction over their boyfriends…until now.
Flustered, she moved behind the bed to avoid his penetrating gaze. She could almost see the tension between them, and the more she acknowledged it, the more aroused she became. She knew she should run. Staying was not only unprofessional, she was afraid she’d have a heart attack. She imagined she could see her heart pounding through her shirt. However, she was more afraid of what would happen if she did run.
Thomas could tell Marty was uncomfortable. He knew he looked terrible, and wondered if she was having second thoughts about her offer of a wash and shave. He cleared his throat.
“You don’t have to do this…” he croaked. “I’m sure I’ll get cleaned up in the morning.” He remembered how he’d been ignoring the aid that poked her head in periodically that morning. He knew that she’d only insist on really cleaning him every few days or so.
“No way are you getting out of it that easy. Let’s get this show on the road.” Marty was astonished at how normal her voice sounded.
She gently lifted his head, hands trembling only slightly, and placed the rubber mat and toweling under his shoulders. She removed the headboard, and maneuvered a chair behind his bed. She lowered the head of the bed until he was tipped slightly down. She pulled the bed-tray holding the water and soap close, and began to sponge his hair.
“Have you had a real bath since the accident?” She hated the red flush she got in response. He cleared his throat. “Never mind, I can guess that’s a no. Ask for one. I know it doesn’t sound like much, but I guarantee you’ll feel a lot better.” The image of Thomas in the hoist, over the tub nearly undid her. She swallowed and dipped the washcloth back in the water.
To be continued...